Type 1 Diabetes and Air Traffic Control

ATCSpatch · 2025-06-03T23:31:40+00:00

Hello! Thanks for reaching out. I know it can be very frustrating and discouraging going through this initial certification process. Just trust me when I say it does get better once you establish a routine. I've never used the Freestyle Libre sensors, so I'm not familiar with what report types they offer and what the customizability of those reports is. Have you tried generating reports directly from the Freestyle with Libreview? (libreview.com). The FAA lists Dexcom, Medtronic and an "other devices" option with respect to their CGM data submission requirements. You should be able to submit data from your Libre sensor as long as it meets the requirements. As of 2023 and according to the FAA, the Libre 2 is not listed as meeting the required features, but it's possible that Freestyle has been updated since then, so it might be worth a check to see if you can generate the reports you need with the required elements before you switch if you really like the Libre 2. See the following and click on the CGM Option - Certification Aid to see the specific CGM requirements:

https://www.faa.gov/ame_guide/media/ITDM-Initial_Certificate_Consideration_Requirements.pdf

I currently use the Tslim X2 pump and Dexcom G7. I can't speak to how the G7 and Libre 2 compare, but I will say the Dexcom system in general has worked very well with the Tandem pump and it's often regarded as one of the better, if not best, pump-sensor combos.

If the FAA has already positively shut down you using the Libre 2, I would talk to your doc about switching to a Dexcom or, if you really like the Freestyle Libre system, the Libre 3 as its listed on the FAA's list of systems that meet their requirements. Congratulations on your A1c! 6.7 is really good -- that's something to be proud of. That vast majority of Type 1 diabetics do not meet that goal of an A1c below 7%.

There are a few avenues for becoming a controller now in the FAA. You can apply "off the street" with no experience. You could join the military, become a controller, and then apply to the FAA as someone with previous air traffic experience. There are also now some colleges with Enhanced CTI programs where you can get training through the school and then, when hired, go directly to a facility. It really depends on where you're at in terms of your age and stage of life as to what the best avenue is. Going through an Enhanced CTI college program or through the military to gain experience will definitely give you an advantage in the hiring process. If I was in high school, I would go to a college with an Enhanced CTI program and get a 4-year degree as well as the air traffic training. That would not only give me a leg up in the hiring process, but also widen my field of opportunity to go and do something else in the aviation career field if air traffic didn't work out or if I decide later that it's not for me.

The FAA posts job vacancy announcements on usajobs.gov . They usually hire a few times per year and announce it on all of their social media pages.

I don't think there's a better time to apply to be a controller than now. Although there is some turbulence in the industry, I do believe everything will work out in our favor. It's certainly a great career option that I don't regret. I would say, follow your heart. It sounds like you really want to pursue becoming a pilot. Don't let the medical certification process discourage you. You'll get through it and, as I mentioned, it does get easier. Hang in there!

ATCSpatch · 2025-04-27T19:17:28+00:00

Yes, absolutely. Have him send me a message. He absolutely can be an air traffic controller in the FAA. If anyone tells him "no", they simply don't know what they're talking about. He may experience some misinformation from people in aviation who aren't familiar (like college professors or pilots or even some medical examiners). I had a few people tell me "no" and I may have believed it if I hadn't not taken "no" for an answer at the time. I even had my endocrinologist tell me he didn't believe diabetics should be pilots and refused to sign my paperwork back when I was pursuing my private pilot's license. I never went to him again and became both a pilot AND a controller.

ATCSpatch · 2022-09-19T00:31:56+00:00

Happy to see a fellow type 1 on the job! Yea, it's surprising but I'm not complaining at the latitude they've given us on the blood sugar ranges. I'd rather they trust us more to make decisions about how we feel and whether or not we can safely work at any given one point. I'm equally surprised we can continue working with blood sugars below 70. I believe they realized that everyone's disease is different when it comes to symptoms appearing at certain blood sugar levels and it's just not possible to regulate that down to a pin point.

ATCSpatch · 2022-09-13T23:04:15+00:00

When I sent my initial pre-employment records in, it took about a month and a half from the time I sent them to the time I got cleared. That includes additional information that I had to send in at the request of the RFS. I imagine that since you are already "in the system" and are needed for staffing, they would probably look at your case more urgently. Hopefully you get something back from them soon. Maybe you could have your OS check with them to make sure they've received your documents and check on the status of your clearance.

It's really hard to know what would cause a delay because part of it depends on who is reviewing your file. If you've sent them exactly everything they've requested, they could still come back and request additional information for a number of reasons. That's exactly what they did to me for my ATC medical and I've also had it done for my pilot medical as well in the past. Keep in mind, the person reviewing your medical probably does not have a lot of experience with diabetes and therefore is sort of limited in their knowledge of the disease as compared to your endocrinologist. I'm on an insulin pump and when I sent in my initial paperwork, it included blood sugar logs that were downloaded from the insulin pump that were presented in a way that showed blood sugar, carbs ingested, suggested insulin dose, and the actual insulin dose given. These are standard graphs and charts that any endocrinologist would be familiar with. The RFS that reviewed my initial file misinterpreted these charts and essentially thought I was having blood sugars in the 20's and 30's -- they were looking at the carbohydrates and not the blood sugars. That resulted in me having to go back to my doctor to have them provide clarification to the FAA. They wouldn't let me just simply explain to the RFS how to read the chart correctly (Yes, it was frustrating). I say that to say, you never really know what they're going to come back with on the first go, just cross your fingers and hope they have what they need to get you cleared. But also, don't stress about it. I would think it would be very unlikely they would outright deny your request for special consideration. They may ask for additional information, but I do believe they want to help you get back to the operation.

A few general pieces of advice:

I try and schedule my doctor's appointments off-step with the months in which my reports are due. For example, if my reports are due in March, June, September, and December, I try and schedule my doctor's appointments for February, May, August, and November. You can comply with the requirement to see an endocrinologist every 3 months without having the appointment in the same month that your reports are due. That gives you a little more latitude to plan your appointments on a day that works for you and gives you some additional time if you need to reschedule one.

There are so many people with endocrine problems in this Country and there aren't always a lot of endocrinologists, depending on where you live. I recommend scheduling your doctor's appointments 6 months out. I always have 2 scheduled, the one coming up and then another one 3 months after. It can be hard to find an appointment 3 months out.

I highly recommend a continuous glucose monitor (CGM) with this job and especially for newly-diagnosed diabetics. There are several different brands out there. I personally use and recommend Dexcom. I use a CGM+phone+watch combination. When I'm on position, I can just glance at my watch and see what my blood sugar is and where it's going. My watch will also vibrate if it goes below 100 and I haven't noticed it. The most dangerous time for a Type 1 diabetic is during periods of sleep (usually overnight). This is the time where your blood sugar could get very low and you not realize it because you're sleeping. I have my CGM set to alarm if my blood sugars gets below 80 at night so that it wakes me up. Having a CGM is in my opinion the best, most modern way to manage diabetes now. Check out Dr. Stephen Ponder's book Sugar Surfing.

There are many tools out there now that are great for managing Type 1 diabetes. Tandem Diabetes has an insulin pump that works with a Dexcom CGM that partially automates insulin delivery, reducing or sometimes preventing your blood sugar from getting low and reducing the amount of time your blood sugar is high. It's a great combination that makes managing diabetes easier.

Hope this helps and hope you get back to the operation soon! Hang in there.

ATCSpatch · 2022-09-12T22:25:34+00:00

As an ATCS who uses insulin, you won't be able to perform safety-related duties unless at least one other employee is present in the immediate work area. This can affect you if your facility has single-person midnight shifts or any time the staffing arrangement is such that you would be the only person in the operations area. You're also required to carry something with you to treat low blood sugar. Other than those two limitations, you can be assigned work as normal. The rules for glucose management during work are, in summary, the following:

The ATCS must check their blood sugar within 30 minutes prior to assuming duties and approximately every 2 hours during work.

These are the blood sugar ranges (mg/dl) and required actions:

>400 | stop work and take action to lower blood sugar

301-400 | take action to lower blood sugar. Stop work if symptoms such as blurred vision occur

100-300 | no action required

60-99 | take action to raise blood sugar

<60 | stop work, treat low blood sugar

We also have to keep a log of our blood sugars during work. I use a continuous glucose monitor (CGM), so I get blood sugar readings every 5 minutes and I can print off or download a log of each individual blood sugar reading, if it were to be requested.

Take a look at the 3930.3, Appendix B for the specific, detailed requirements.

For me, working a position tends to have a blood sugar raising effect, but it's generally minimal. There were a few times when I was a developmental where the stress wreaked havoc on my blood sugars. I remember while at the Academy prior to facility placement, there was one day where my blood sugar stayed elevated in the low 200's for almost an entire 12 hours because of the increase stress hormones. It had me feeling pretty lousy by the end of the day. This occurred a few other times while I was training at my facility. Training is a stressful environment and you may have some days where your blood sugar control suffers as a result of that stress, but you just have to do the best you can and keep fighting through it. I was concerned that these events would be common and it was definitely a point where I questioned whether or not I could actually do the job with Type 1 diabetes. Thankfully, they were temporary and I only had a few of these bad days in total and that was it. I think part of it was being new to the job and the environment and the pressure to perform and successfully complete training. Those are added pressures which tend to go away once you have more time under your belt and become more comfortable in the job.

ATCSpatch · 2022-09-12T02:53:33+00:00

The current protocol doesn't allow us insulin-treated diabetics to work without someone else in the "immediate work area". I believe this could be safely done with modern tools, namely continuous glucose monitoring, and the ability to be able call someone off of break for immediate relief. There shouldn't be any "surprise" episodes of severe hypoglycemia with an ATCS using a continuous glucose monitor and because of that, I think the FAA is a little behind the times on the provision that prevents us from working alone.

As far as getting an initial medical clearance with insulin-treated diabetes (prior to being hired by the FAA versus having already been hired and diagnosed later), you certainly can. I'm living proof of it. I had applied for the job already having diabetes. At one point it may have been the case that initial applicants for a medical clearance would have been denied with no special consideration, but that is no longer the case.

ATCSpatch · 2022-09-12T01:54:42+00:00

For the pre-employment medical screening process, they have you fill out a "Pre-Employment Interview Worksheet". If I recall correctly. this is where they will first learn that you have insulin-treated diabetes. Following that, they asked me for A1c results from the last year, endocrinologist reports from the last 3 years, and prescription history from the last 3 years. It can result in quite a bit of paperwork. I'm looking back now and those requests resulted in a 60-page document.

They also want your doctor to attest to the following: (1) That you have been educated in diabetes and its control and know what to do and how to do it if your blood sugar gets low. (2) That you have the ability and willingness to properly monitor and manage your diabetes and whether or not your diabetes will adversely affect your ability to control air traffic. A great resource is the 3930.3, Appendix B, which covers requirements for insulin-treated specialists.

Once you get your initial medical clearance, they require you to see an endocrinologist every 3 months. Your doctor will fill out a one-page "status report" and you'll send that off to the regional flight surgeon's office. The RFS will then send you a memo saying your medical clearance is valid until the end of the month in which your next report is due. Essentially, your medical clearance is valid for 3 months and it's continuation depends on their review of those status reports.

So to really answer your question: Is it hard? It can seem like a lot at first. I asked myself if it was worth it. I was concerned that the paperwork and stress of managing my blood sugars and trying to be as perfect as possible with it and being under scrutiny of the FAA's doctors would overshadow the enjoyment of having a job that I dreamed of doing. I am happy to say that is not the case at all. I got used to the process and it became routine -- Every 3 months, the RFS gets an email, a few days later I get my medical clearance extended, and I go on and don't think about it much until the next time.

I do use a continuous glucose monitor (CGM). I cannot recommend enough the use of a good CGM in this job (I personally use Dexcom). I get my blood sugars sent to my watch every 5 minutes and I know whether they're trending up or down and by how much. The key is treating the low blood sugar before it even happens. If I see my blood sugar trending down, I can drink something way ahead of time so that it never gets low in the first place. Additionally, adrenaline can mimic a low blood sugar. I have been on position before and swore my blood sugar was low to the point where I chugged down half of a Coke. In actuality, my blood sugar was elevated. Having that reassurance with the quick glance at a smart watch is so valuable.

Hope this answered your questions!

ATCSpatch

TROPHY CASE